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Andrei D Sdrulla, Yun Guan, Srinivasa N Raja
The field of spinal cord stimulation (SCS) owes its inception to the concept of gate control theory (GCT), put forth by Wall and Melzack in their landmark 1965 paper, which proposed that "control of pain may be achieved by selectively activating the large, rapidly conducting fibers". The first reported clinical application of dorsal column stimulation came 2 years later, and the field has gradually expanded ever since. Today, an estimated 50,000 spinal cord neurostimulators are implanted annually...
March 11, 2018: Pain Practice: the Official Journal of World Institute of Pain
Mats De Jaeger, Robbert-Jan van Hooff, Lisa Goudman, Alexis Valenzuela Espinoza, Raf Brouns, Martine Puylaert, Wim Duyvendak, Maarten Moens
Background: Spinal cord stimulation (SCS) is a proven and effective treatment for neuropathic pain conditions such as failed back surgery syndrome (FBSS). The hypothesis that different settings for SCS parameters activate unique, pain-relieving mechanisms has boosted the development of various SCS paradigms. High density spinal cord stimulation (HD-SCS) is one of those promising, novel stimulation forms characterized by subthreshold stimulation, delivering more pulses per second and a higher pulse density to the spinal cord than conventional SCS...
June 2017: Anesthesiology and Pain Medicine
Juntaro Matsumoto, Toyohiko Isu, Kyongsong Kim, Naotaka Iwamoto, Kazuyoshi Yamazaki, Daijiro Morimoto, Masanori Isobe
INTRODUCTION: Some patients suffer failed back surgery syndrome (FBSS) after lumbar spine surgery. We report the effect of additional treatments for para-lumbar- and peripheral nerve diseases addressing residual symptoms after lumbar spine surgery. MATERIALS AND METHODS: We enrolled 74 patients (59 men and 15 women, mean age 62.9 years) who had undergone lumbar posterior decompression surgery in our department. Mean follow-up after initial lumbar surgery was 26...
January 31, 2018: World Neurosurgery
Michelle Granville, Aldo F Berti, Robert E Jacobson
Spinal cord stimulation (SCS) is an effective treatment for chronic back and limb pain. The criteria for use of SCS for specific problems such as failed back surgery syndrome (FBSS), peripheral neuropathic pain and residual pain after joint replacement is well established. With an aging population, there are more patients presenting with a combination of various multi-factorial chronic pain problems rather than from a single clear cause. It is not uncommon to see patients with chronic back pain years after spine surgery with new additional pain in the area of joint replacement or due to peripheral neuropathy...
November 17, 2017: Curēus
S J Tuijp, J Van Zundert, P De Vooght, M Puylaert, R Mestrum, R Heylen, P Vanelderen
BACKGROUND AND AIMS: Persistent low back pain after initially successful surgery that is not attributed to structural deficits, is called failed back surgery syndrome (FBSS). When conservative and minimal invasive therapy fail, the recommended treatment is spinal cord stimulation (SCS). Because epidural fibrosis can be a contributing factor in the majority of FBSS patients, lumbosacral epiduroscopic lysis of adhesions may be considered as a less invasive alternative treatment option. We hypothesized that the use of epiduroscopic lysis of adhesions could reduce the need for SCS...
January 18, 2018: Pain Practice: the Official Journal of World Institute of Pain
Bart Billet, Roel Wynendaele, Niek E Vanquathem
Objective: To evaluate the analgesic effect of a dorsal root ganglion (DRG) stimulation technology utilizing high-frequency pulse rates to treat intractable chronic back and leg pain. Methods: This case study presents the outcomes, with a novel, wireless, minimally invasive miniature neurostimulator system in a case of chronic back pain. The subject was implanted bilaterally with a Freedom 4A quadripolar electrode array at the L2 dorsal root ganglion. Stimulation was applied using 10 kHz pulse rate and 30 μs pulse width...
2017: Case Reports in Medicine
Ryan J Galica, Salim M Hayek, Elias Veizi, Matthew T McEwan, Sivakanth Katta, Omar Ali, Nida Aziz, Nidhi Sondhi
OBJECTIVES: Intrathecal (IT) trial is a prognostic interventional pain management procedure employed to determine the potential success of treating intractable pain with an implantable infusion device system. There is a dearth of data regarding trials with continuous infusion of combination therapy (e.g. opioid combined with local anesthetic). The objective of the this study was to determine the overall outcomes of continuous infusion IT trials and factors influencing long-term success of IT therapy in patients with chronic intractable pain post-laminectomy...
December 5, 2017: Neuromodulation: Journal of the International Neuromodulation Society
Jose De Andres, Vicente Monsalve-Dolz, Gustavo Fabregat-Cid, Vicente Villanueva-Perez, Anushik Harutyunyan, Juan Marcos Asensio-Samper, Nerea Sanchis-Lopez
Objectives: Spinal cord stimulation (SCS) for patients with failed back surgery syndrome (FBSS) show variable results and limited to moderate evidence. In the last years the stimulation of high frequency (HF) has been considered as a better alternative in this pathology for its supposed benefits compared to the stimulation with conventional frequency (CF). To compare in one year follow-up, the efficacy of high-frequency SCS (HF) versus conventional frequency SCS (CF) on the patients with FBSS...
December 1, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
Lisa Goudman, Iris Smet, Peter Mariën, Mats De Jaeger, Sander De Groote, Eva Huysmans, Koen Putman, Jean-Pierre Van Buyten, Ronald Buyl, Maarten Moens
OBJECTIVES: To understand the subjective pain experience of patients, healthcare providers rely heavily on self-reporting. However, to quantify this unique pain experience, objective parameters are not yet available in daily clinical practice. With regard to patients with failed back surgery syndrome (FBSS) treated with spinal cord stimulation (SCS), pain therapists may recover the individual functional information about the patient's posture from the implantable pulse generator (IPG) of the stimulator...
January 2018: Neuromodulation: Journal of the International Neuromodulation Society
M Carassiti, A Di Martino, A Centonze, C C Quattrocchi, A Caldaria, F Agrò, V Denaro
PURPOSE: Evaluate the efficacy and safety of MESNA (sodium 2-mercaptoethanesulfonate) injection into the epidural space in the FBSS. METHODS: We designed a prospective phase II longitudinal study. Six consecutive patients were enrolled. Patients underwent one peridural injection per week for 3 weeks. NRS and ODI were investigated before and 48 h after injections, and at 1 week, 1 month and 2 months after the last procedures. Opioids intake is investigated before procedures and 1 week, 1 month and 3 months after the last procedures...
November 2, 2017: Musculoskeletal Surgery
Koji Tamai, Zorica Buser, Christopher Wang, Permsak Paholpak, Hiroaki Nakamura, Jeffrey C Wang, Patrick C Hsieh
Studies have demonstrated superior outcomes and cost effectiveness of the spinal cord stimulation (SCS) for the treatment of chronic pain syndromes such as failed back surgery syndrome (FBSS) or complex regional pain syndrome (CRPS). However, little is known about the impact of primary diagnosis or mental disorders on the revision rate. This is the Retrospective cohort study to analyze the reintervention rates based on the primary diagnosis or comorbid mental disorder. Data of the annual trends of SCS use, revision and removal rate of SCS and additional surgical rate after removal was collected and analyzed for patients undergoing SCS between 2007 and 2015, within a private insurance billing database...
January 2018: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Riham Dessouky, Mohammed Khaleel, Dalia N Khalifa, Hazim I Tantawy, Avneesh Chhabra
STUDY DESIGN: Retrospective clinical case series. OBJECTIVE: To study the role of MRN of lumbosacral plexus in management of patients with FBSS. SUMMARY OF BACKGROUND DATA: Failed back surgery syndrome (FBSS) is one of the major problems in health care, affecting up to 40% of patients following spine surgery. To date, no imaging modality has been used to effectively classify nerve compression, since nerve injuries are challenging to detect on conventional lumbar spine MRI...
October 12, 2017: Spine
Motoyuki Iwasaki, Masahiko Akiyama, Izumi Koyanagi, Yoshimasa Niiya, Tatsuo Ihara, Kiyohiro Houkin
We present a case of double-crushed L5 nerve root symptoms caused by inside and outside of the spinal canal with spur formation of the lumbosacral transitional vertebra (LSTV). A 78-year-old man presented with 7-year history of moderate paresis of his toe and left leg pain when walking. Magnetic resonance imaging (MRI) revealed spinal stenosis at the L3/4 and 4/5 spinal levels and he underwent wide fenestration of both levels. Leg pain disappeared and 6-min walk distance (6MWD) improved after surgery, however, the numbness in his toes increased and 6MWD decreased 9 months after surgery...
October 2017: NMC Case Report Journal
Conrad Harrison, Sarah Epton, Stana Bojanic, Alexander L Green, James J FitzGerald
OBJECTIVE: Dorsal root ganglion stimulation (DRGS) received its first regulatory approval (CE marking in Europe) in late 2011, and so its use is now almost six years old. Several thousand patients have already been treated, and a landmark trial in lower limb complex regional pain syndrome (CRPS) and causalgia has recently been published. METHODS: In this review we have summarized the literature to date on the use of DRGS in the treatment of neuropathic pain. RESULTS: The results so far are encouraging, with reports of successful use in treating a wide range of indications including postsurgical pain, CRPS, and phantom pain...
September 28, 2017: Neuromodulation: Journal of the International Neuromodulation Society
S Harrison Farber, Jing L Han, Frank W Petraglia Iii, Robert Gramer, Siyun Yang, Promila Pagadala, Beth Parente, Jichun Xie, Jeffrey R Petrella, Shivanand P Lad
BACKGROUND: Failed back surgery syndrome (FBSS) has a high incidence following spinal surgery, is notoriously refractory to treatment, and results in high health care utilization. Spinal cord stimulation (SCS) is a well-accepted modality for pain relief in this population; however, until recently magnetic resonance imaging (MRI) was prohibited due to risk of heat conduction through the device. OBJECTIVES: We examined trends in imaging use over the past decade in patients with FBSS to determine its impact on health care utilization and implications for patients receiving SCS...
September 2017: Pain Physician
S Harrison Farber, Jing L Han, Aladine A Elsamadicy, Qasim Hussaini, Siyun Yang, Promila Pagadala, Beth Parente, Jichun Xie, Shivanand P Lad
BACKGROUND: Failed back surgery syndrome (FBSS) is a cause of significant morbidity for up to 40% of patients following spine surgery, and is estimated to cost almost $20 billion. Treatment options for these patients currently include conventional medical management (CMM), repeat operation, or spinal cord stimulation (SCS). Much of the published data regarding cost effectiveness of SCS comprise smaller scale randomized controlled trials (RCTs) rather than large databases capturing practices throughout the US...
September 2017: Pain Physician
Jae Hwan Cho, Jae Hyup Lee, Kwang-Sup Song, Jae-Young Hong
Neuropathic pain after spinal surgery, the so-called failed back surgery syndrome (FBSS), is a frequently observed troublesome disease entity. Although medications may be effective to some degree, many patients continue experiencing intolerable pain and functional disability. Only gabapentin has been proven effective in patients with FBSS. No relevant studies regarding manipulation or physiotherapy for FBSS have been published. Spinal cord stimulation (SCS) has been widely investigated as a treatment option for chronic neuropathic pain, including FBSS...
August 2017: Asian Spine Journal
Jeffrey A O'Donnell, Joshua T Anderson, Arnold R Haas, Rick Percy, Stephen T Woods, Uri M Ahn, Nicholas U Ahn
STUDY DESIGN: Retrospective cohort. OBJECTIVE: Determine the impact of preoperative opioid use in workers' compensation (WC) patients undergoing lumbar diskectomy (LD). SUMMARY OF BACKGROUND DATA: The prevalence of back pain among opioid users approached 60%. Long term opioid dependence in spine surgery patients is roughly 20%. Despite pervasive use, there is no evidence to support long-term opioid analgesic use for back pain. METHODS: 10,592 patients received compensation from the Ohio Bureau of Workers' Compensation for a lumbar disc herniation between 2005-2012...
August 23, 2017: Spine
Shen Liu, Guoqing Pan, Guangwang Liu, José das Neves, Sa Song, Shuai Chen, Bangjun Cheng, Zhiyong Sun, Bruno Sarmento, Wenguo Cui, Cunyi Fan
Electrospun fibrous membranes provide suitable physical anti-adhesion barriers for reducing tissue anti-adhesion following surgery. However, often during the biodegradation process, these barriers trigger inflammation and cause a foreign body reaction with subsequent decrease in anti-adhesion efficacy. Here, a facile strategy comprising the incorporation of ibuprofen (IBU) into implantable membranes and its sustained release was proposed in order to improve anti-adhesion effects and neurological outcomes, namely to prevent failed back surgery syndrome (FBSS)...
October 28, 2017: Journal of Controlled Release: Official Journal of the Controlled Release Society
Dylan J H A Henssen, Nicole Scheepers, Erkan Kurt, Inge Arnts, Monique Steegers, Kris Vissers, Robert van Dongen, Yvonne Engels
BACKGROUND: Spinal cord stimulation (SCS) is an effective therapy to reduce pain in patients that suffer from failed back surgery syndrome (FBSS). In order to inform patients optimally prior to this therapy, knowing their expectations is crucial. METHODS: Thirteen patients suffering from FBSS and scheduled for SCS were interviewed, using a semi-structured protocol. Patients were interviewed either at home or at their treating hospital. Data from these interviews were analyzed using directed content analysis...
July 25, 2017: Pain Practice: the Official Journal of World Institute of Pain
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